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Physiological jaundice

By AdminPosted On 05-Oct-2016

1. Cause of Physiological Jaundice

Which one of the following is the major contributor to the development of physiological jaundice?

a) Breastfeeding.
b) Decreased hepatic bilirubin excretion.
c) Immature hepatic enzymes.
d) Enterohepatic circulation.
e) Increased bilirubin production.

Correct Answer: e) Increased bilirubin production. The major cause of physiological jaundice is increased bilirubin production due to increased haemoglobin levels at birth and a shortened red cell lifespan. Option 'b' and 'c' does play a minor role. Enterohepatic circulation does have a significant contribution.

2. Jaundice in 24 h

Which one of the following is the most important cause of jaundice presenting in the first 24 h of life to EXCLUDE ?

a) Prematurity.

b) Haemolysis

c) Breastfeeding.

d) Physiological jaundice.

e) Early-onset sepsis.

Correct Answer: b) Haemolytic jaundice is the most important cause of jaundice presenting on the first day of life and needs to be excluded. Physiological jaundice and of prematurity normally presents after 24 hours of age. Limited volumes of breast milk are obtained in the first 24 hours of life and breast feeding does not cause jaundice in the first 24 hours of life.

3. Jaundice on D2

A neonate born at 40 weeks of gestation presents with jaundice at 36 hrs of life. There is no sign of infection

a) Commence phototherapy to render bilirubin water soluble

b) Conjugated and unconjugated bilirubin are present in the urine

c) Conjugated bilirubin stains the urine dark

d) Treat with antibiotic

Correct Answer: a) Commence phototherapy to render bilirubin water soluble. Please refer to the Guidelines by American Academy of Pediatrics (AAP)

4. Jaundice on D5

What should be measured in a newborn (5 days old) who presents with hyperbilirubinemia?

a) Total and direct bilirubin

b) Total bilirubin

c) Direct bilirubin

d) Conjugated bilirubin only

e) Direct phototherapy without any blood tests.

Correct Answer: b) Total bilirubin. Usually, a total serum bilirubin level test is the only one required in an infant with moderate jaundice who presents on the typical second or third day of life without a history and physical findings suggestive of a pathologic process. Question does not mention of any pathological process. Measurement of bilirubin fractions (conjugated vs unconjugated) in serum is not usually required in infants who present as described above. However, in infants who have hepatosplenomegaly, petechiae, thrombocytopenia, or other findings suggestive of hepatobiliary disease, metabolic disorder, or congenital infection, early measurement of bilirubin fractions is suggested. The same may apply to infants who remain jaundiced beyond the first 7-10 days of life, and to infants whose total serum bilirubin levels repeatedly rebound following treatment. JAUNDICE THAT PRESENTS AT LESS THAN 24 HOURS OF AGE requires total and direct bilirubin. 

5. Jaundice and clay white stools

Neonate presents with jaundice and clay white stools. On liver biopsy giant cells are seen. Most likely diagnosis is

a) Physiological jaundice

b) Neonatal hepatitis with extrabiliary atresia

c) Neonatal hepatitis with physiological jaundice

d) Extrabiliary atresia

e) Gilbert's syndrome

Correct Answer: b) Neonatal hepatitis with extrabiliary atresia. Liver biopsy is useful to differentiate between intra and extrahepatic causes of neonatal cholestasis. In billiary atresia, ductal proliferation and fibrosis are seen whereas in neonatal hepatitis, alteration in lobular architecture, focal hepatocellular necrosis, giant cells with balooning of their cytoplasm.

6. Direct Hyperbilirubinemia

Causes of predominantly direct hyperbilirubinemia in neonate include all EXCEPT

a) Dubin Johnson syndrome

b) Rotor’s disease.

c) Extra hepatic biliary atresia

d) Gilbert’s disease

e) Stone in common bile duct

Correct Answer: d) Gilbert’s disease
Conjugated hyperbilirubinemia results from reduced secretion of conjugated bilirubin into the bile, such as occurs in patients with hepatitis, or it results from impaired flow of bile into the intestine, such as occurs in patients with biliary obstruction.
Gilbert's syndrome: reduced activity of the enzyme glucuronyltransferase, which conjugates bilirubin. They have predominantly have elevated unconjugated bilirubin, while conjugated bilirubin is usually within the normal range.

7. ABO incompatibility

Which one of the following combinations, ABO incompatibility is most common?

a) Mother’s group ‘A’ and father’s group ‘O’

b) Mother’s group ‘A’ and father’s group ‘B’

c) Mother’s group ‘O’ and father’s group ‘A’

d) Mother’s group ‘B’ and father’s group ‘AB’

Correct Answer: c) Mother 'O' and Father 'A". Some mothers may be sensitized by fetal-maternal transfusion of ABO incompatible red blood and produce immune IgG antibodies against the antigen they do not have and their baby does. For example, when a mother of genotype OO (blood group O) carries a fetus of genotype AO (blood group A) she may produce IgG anti-A antibodies. The father will either have blood group A, with genotype AA or AO, or more rarely, have blood group AB, with genotype AB.

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